Healthcare Provider Details

I. General information

NPI: 1245105634
Provider Name (Legal Business Name): DIANA GRACE LIN, DMD, MPH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 WAKEFIELD PINES DR STE 100
RALEIGH NC
27614-7078
US

IV. Provider business mailing address

2810 WAKEFIELD PINES DR STE 100
RALEIGH NC
27614-7078
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-2194
  • Fax:
Mailing address:
  • Phone: 919-488-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANA GRACE LIN
Title or Position: OWNER
Credential: DMD, MPH
Phone: 657-262-5042